Effective June 1, Spravato™ will be added the prior authorization program for Blue Cross and BCN commercial members.
Effective June 1, 2019, Spravato™ (esketamine, HCPCS code J3490) will be added to the Medical Drug Prior Authorization Program for Blue Cross Blue Shield of Michigan PPO and BCN HMOSM (commercial) members. This applies to any members covered by commercial plans who are starting therapy on or after June 1.
The authorization requirement only applies to groups that are currently participating in the commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. These changes don't apply to BCN AdvantageSM, Medicare Plus BlueSM PPO or Federal Employee Program® members.
As a reminder, approval of an authorization request isn't a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members. Members are responsible for the full cost of medications not covered under their medical benefit coverage.
The new requirements for Spravato™ will appear in the list of requirements for drugs covered under the medical benefit - BCN HMO and Blue Cross PPO before the June 1 start date.
For additional information about drugs covered under the medical benefit, visit the ereferrals.bcbsm.com website:
Posted: May 2019
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network